Psychiatric eponymns: Cotard syndrome

The Cotard delusion or Cotard’s syndrome is named after Jules Cotard (1840–1889), a French neurologist. Its more dramatic name is ‘walking corpse syndrome’ and it is characterized by the presence of nihilistic delusional ideation.

Cotard first described the syndrome, calling it le délire de négation, at a lecture in Paris in 1880 whereupon he described ‘Mademoiselle X’ patient who denied the existence of God, the Devil, several parts of her body, and also her need to eat. Later she believed she was eternally damned and could no longer die a natural death. She eventually died of starvation.

In a textbook example of the presentation a patient would hold a delusional belief that they are dead, do not exist, are putrefying, or have lost their blood or internal organs. There may also be olfactory hallucinations, for instance of rotting flesh. The disorder tends to occur intermittently rather than being chronic and may be a feature of mood disorder, schizophrenia or organic disorders.

Neurologically, Cotard’s is thought to be related to Capgras’s syndrome, and both are thought to result from a disconnect between the brain areas that recognize faces and the those that associate emotions with that recognition. It is hypothesized that if a person recognizes a face but does not experience the expected emotional reaction then an erroneous conclusion can be drawn. If the face in question is that of a relative or friend then a patient’s lack of emotional reaction is interpreted as being as a result of the relative actually being an impostor. This is Capgras syndrome. However if it is the patient’s own face that is not recognised this leads the patient toward a sense that they do not exist and a Cotard syndrome is evident.

The protagonist of Charlie Kaufman’s debut feature film Synecdoche New York is called Caden Cotard.

I was in my local bank a while ago when I was absolutely astounded to see a person calmly walking out in a balaclava and gloves. As I watched the person leave, it was clear from the body shape and other clothes that this person was an elderly lady – complete with shopping bag on wheels.

As I’m sure everyone would be, I was really shocked. When it was my turn at the counter, I asked the teller if their clients had a habit of coming in dressed in balaclavas and gloves. I was told that the reason the lady dressed so strangely is that she believes she is dead and this is how to get people to see her.

So next time you see a person in a bank in east London, fear not. It’s probably just someone with Cotard Syndrome!

Hi there, as a researcher for a short film about a person with Cotard syndrome and am looking for a neurological specialist or anyone with professional insight into the syndrome so that our film is as accurate as possible.